Abstract

Introduction

Rapid response teams (RRTs) have been shown to reduce cardiopulmonary arrests outside
the intensive care unit (ICU). Yet the utility of RRTs remains in question, as most
large studies have failed to demonstrate a significant reduction in hospital-wide
mortality after RRT implementation.

Methods

A cohort design with historical controls was used to determine the effect on hospital-wide
mortality of an RRT in which clinical judgment, in addition to vital-signs criteria,
was widely promoted as a key trigger for activation. All nonprisoner patients admitted
to a tertiary referral public teaching hospital from 2003 through 2008 were included.
In total, 77, 021 admissions before RRT implementation (2003 through 2005) and 79,
013 admissions after RRT implementation (2006 through 2008) were evaluated. The a priori primary outcome was unadjusted hospital-wide mortality. A Poisson regression model
was then used to adjust for hospital-wide mortality trends over time. Secondary outcomes
defined a priori were unadjusted out-of-ICU mortality and out-of-ICU cardiopulmonary-arrest codes.

Conclusions

Implementation of an RRT in which clinical judgment, in addition to vital-signs criteria,
was widely cited as a rationale for activation, was associated with a significant
reduction in hospital-wide mortality, out-of-ICU mortality, and out-of-ICU cardiopulmonary-arrest
codes. The frequent use of clinical judgment as a criterion for RRT activation was
associated with high RRT utilization.